Evidence does not support statin use for conditions other than heart disease

October 08, 2018

Annals of Internal Medicine Tip Sheet

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. Evidence does not support statin use for conditions other than heart disease

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0808
URLs go live when the embargo lifts Despite studies suggesting benefits for conditions beyond cardiovascular disease (CVD), the evidence does not support revising current statin prescribing guidelines. Findings from an evidence review and meta-analysis are published in Annals of Internal Medicine.

Statins are a group of medicines commonly used to lower cholesterol levels in the blood and their benefits for reducing the risk of heart disease and stroke are well-established. Some studies have suggested that statins may help patients with non-CVD conditions, but the evidence is not as clear.

Researchers led by the University of Edinburgh analyzed results from 256 studies that had investigated the benefits of taking statins for 278 non-CVD conditions. They found that statins can help to prevent deaths from kidney disease, which is already recognized in clinical guidelines, but there is no clear evidence that statins can help improve kidney function. Researchers also found evidence that statins can help slow cancer progression, but further investigation is needed. Further investigation is also needed to determine how statins affect COBD disease progression and Alzheimer's disease.

According to the study authors, the lack of convincing evidence of an association between statins and non-CVD outcomes supports leaving the current recommendations unchanged.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author Evropi Theodoratou, PhD, please contact Jen Middleton at Jen.Middleton@ed.ac.uk.

2. Fragmented prescribing associated with higher risk for opioid and benzodiazepine overlap

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0852
URLs go live when the embargo lifts

Receiving medications from both the U.S. Department of Veterans Affairs and Medicare Part D, compared to receiving medications from either VA or Medicare alone, is associated with much higher risk of potentially dangerous overlapping of opioid and benzodiazepine prescriptions. Findings from a cross-sectional study are published in Annals of Internal Medicine.

Concurrent use of prescription opioids and benzodiazepines is associated with increased risk for overdose and death. This type of overlap is now cautioned against by opioid product labeling, VA guidelines, and opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC). It is also measured and tracked by the Pharmacy Quality Alliance. Still, veterans that receive medications from both the VA and Medicare may be at higher risk this type of overlapping.

Researchers from the VA Pittsburgh Health Care System and the University of Pittsburgh studied health records for all veterans (over 360,000 individuals) enrolled in both VA and Medicare Part D who filled at least two opioid prescriptions in 2013 to assess the association between dual use of drug benefits and the receipt of overlapping opioid and benzodiazepine prescriptions. The researchers found that receiving prescription medications from both the VA and Medicare was associated with a 27 percent increased risk for overlapping opioid and benzodiazepine prescriptions and more than twice the risk for overlapping high-dose opioids and benzodiazepines, compared with receiving prescriptions from the VA alone. The more fragmented the prescription use (the more evenly split medications are between VA and Part D), the greater the risk. Receipt of prescriptions from both the VA and Medicare was also associated with greater risk for opioid-benzodiazepine overlap compared with Medicare alone, although the magnitude of the difference was smaller.

According to the researchers, these findings suggest that receipt of medications from more than one health care system is a key risk factor for unsafe prescribing practices.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Gellad, Walid, MD, MPH, please contact Allison Hydzik at hydzikam@upmc.edu.

3. About 1.9 million current vapers have never smoked cigarettes

Geographically, Michigan had the highest prevalence of sole e-cigarette users and Alaska had the lowest

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1826

Editorial: http://annals.org/aim/article/doi/10.7326/M18-2581
URLs go live when the embargo lifts

Approximately 1.9 million adults who currently use e-cigarettes have never smoked tobacco cigarettes. Of note, 60 percent of sole e-cigarette users were younger than 25 years old. A brief research report is published in Annals of Internal Medicine. Cigarette smoking is the leading cause of preventable death in the United States. As such, e-cigarette use has increased as a way for people to quit smoking. However, public health authorities worry that the uptake of e-cigarette use among people who have never smoked tobacco may overtake the potential utility of e-cigarettes as smoking cessation aids. Researchers from the American Heart Association used data from the Behavioral Risk Factor Surveillance System 2016 to examine the age distribution, state-level prevalence, health perceptions, and behaviors of U.S. adults who were sole-e-cigarette users. The researchers found that about 1.4 percent of the U.S. adult population were sole e-cigarette users and about 17.7 percent of them vaped daily. Michigan had the highest prevalence of sole e-cigarette users and Alaska had the lowest.

Sole e-cigarette users had a higher prevalence of high-risk lifestyle factors (binge drinking, high risk sexual behaviors, and marijuana use) had worse self-rated mental and physical health compared to nonusers. This is the first study to describe other lifestyle habits of sole e-cigarette users. Prior research has suggested that sole e-cigarette use might serve as a gateway to combustible cigarette smoking or illicit drug user - however, this could be not assessed in this study. Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Michael Blaha, MD MPH, please contact Vanessa McMains, Ph.D. at vmcmain1@jhmi.edu.

4. Lung cancer rates projected to drop dramatically over the next 50 years due to long-standing tobacco control efforts
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1250

URLs go live when the embargo lifts

Tobacco control efforts implemented in the 1960s will continue to reduce lung cancer rates well into the next half-century. Since smoking will also continue to be an important determinant of lung cancer risk, continued policies and measures discouraging the uptake of smoking in youth and to promote cessation among current users will be needed. Findings from a comparative modeling study are published in Annals of Internal Medicine.

Researchers from the Cancer Intervention and Surveillance Modeling Network (CISNET) and the University of Michigan developed four computer models using U.S. data on smoking (1964 to 2015) and lung cancer mortality (1969 to 2010) to project reductions in tobacco use and lung cancer mortality from 2015 to 2065 attributable to existing tobacco control efforts. The models suggest that while lung cancer mortality due to smoking is expected to decrease overall, lung cancer will remain a significant health problem in the United States. Specifically, the number of annual deaths from lung cancer will decrease from 135,000 in 2015 to 50,000 in 2065. Still, 4.4 million deaths from lung cancer are still projected to occur over that same timeframe, with a majority occurring in those who had never smoked.

According to the researchers, these findings suggest that maintaining existing tobacco control efforts will result in considerable reductions in the lung cancer burden in the United States.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Rafael Meza, please contact Nardy Baeza Bickel at nbbickel@umich.edu.
Also new in this issue:

Researcher Requests for Inappropriate Analysis and Reporting: A U.S. Survey of Consulting Biostatistician
Min Qi Wang, PhD; Alice F. Yan, MD, PhD; Ralph V. Katz, DMD, MPH, PhD
Research and Reporting Methods
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1230
Editorial: http://annals.org/aim/article/doi/10.7326/M18-2516

San Francisco Voters End the Sales of Flavored Tobacco Products despite Strong Industry Opposition
Y. Tony Yang, ScD, LLM, MPH; Stanton Glantz, PhD

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2317

The FDA's dilemma: How tightly to regulate electronic cigarettes?
Steven A. Schroeder, MD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2738

American College of Physicians

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